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General NPI Number Information
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NPI Number | 1508711904
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Entity Type | Individual
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Provider Name | CHARLA GERI BLACKWELL
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Gender | Female
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 613 MARQUETTE RD
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City | BRANDON
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State | MS
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Zip | 39042-3038
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Country | US
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Telephone | 601-824-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 128 WILLOW CREST CIR
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City | BRANDON
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State | MS
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Zip | 39047-7064
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 883208
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License Number State | MS
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